In cases of severe obesity, patients can undergo various types of surgical procedures to tie off, staple, or bypass portions of the stomach and gastrointestinal tract (e.g., large intestine or small intestine). These procedures can reduce the amount of food desired and ingested by the patient, thereby causing the patient to lose weight.
One surgical procedure, known as a Roux-En-Y gastric bypass, creates a permanent surgical reduction of a patient's stomach volume and a bypass of the patient's intestine. In the procedure, the stomach is separated into a smaller, upper stomach pouch and a larger, lower stomach pouch, such as by using a stapling device. A segment of the patient's small intestine (e.g., a segment distal of the duodenum or proximal of the jejunum) is then brought from the lower abdomen and joined with the upper stomach pouch created through a half-inch opening, or stoma, in the stomach pouch and small intestine. This segment of the small intestine, known as the “Roux loop,” carries food from the upper stomach pouch to the remainder of the intestines, where the food is digested. The remaining lower stomach pouch and the attached segment of duodenum are then reconnected to form another anastomotic connection to the Roux loop at a location approximately 50-150 cm (1.6-4.9 ft) from the stoma, typically using a stapling instrument. From this connection, digestive juices from the bypassed stomach (e.g., the lower stomach pouch), pancreas, and liver enter the jejunum or ileum to aid in digestion. The relatively small size of the upper stomach pouch therefore reduces the amount of food that the patient can eat at one time, thereby leading to weight loss in the patient.
While the Roux-En-Y gastric bypass procedure maintains oral access to the upper stomach pouch, the procedure eliminates oral access to the bypassed lower stomach. In certain cases, such as when a patient becomes ill following the Roux-En-Y gastric bypass, the patient can require either delivery of nutrients and fluids to the bypassed lower stomach pouch or removal of excess digestive juices from the bypassed lower stomach. To provide external access to the lower stomach pouch, a percutaneous endoscopic gastrostomy (PEG) tube can be inserted within the pouch.
Conventional PEG tubes include a flexible tube having a balloon positioned on a distal end of the tube. The PEG tube is implanted by inserting the distal end of the PEG tube through openings formed within the abdominal muscle wall of the patient and the lower stomach pouch to position the deflated balloon within the lower stomach pouch. The balloon is then inflated to engage the lower stomach pouch wall to secure the PEG tube to the stomach pouch. Fluids can then be introduced into or removed from the stomach pouch via the PEG tube.
In some Roux-En-Y gastric bypass procedures, the lower stomach pouch can be difficult to subsequently locate and access within the patient (e.g., at a time subsequent to the gastric bypass procedure). The PEG tube can thus also be used to reposition the lower stomach pouch in proximity to the abdominal wall. This can be achieved by pulling the flexible tube after the balloon is inflated to pull the lower stomach pouch toward the abdominal wall. Eventually, the adhesion will be formed between the lower stomach pouch and the abdominal wall to permanently anchor or secure the tissues to each other.
While the use of conventional PEG tubes can be an effective mechanism to deliver or withdraw fluids from the lower stomach pouch, or to position a lower stomach pouch relative to an abdominal wall, there are some drawbacks with current PEG tubes. For example, during operation of the PEG tube, the balloon should only be inflated to an amount that is necessary to engage the stomach pouch, as over inflation of the balloon can create excess pressure within the stomach. However, it may be necessary to inflate the balloon to an undesirably large size in order to allow the balloon to engage the stomach wall without passing through the opening. The use of a balloon can also pose the risk of over inflation leading to rupture or leakage during use, thereby limiting the ability for the PEG tube to maintain its anchored position within the lower stomach pouch.
Accordingly, there is a need for improved methods and devices for securing a PEG tube within a lower stomach pouch following a Roux-En-Y gastric bypass.